Adrenalectomy
Indications
- Phaeochromocytoma
- Adrenal carcinoma / adenoma
- Non functioning incidentaloma > 4cm in diameters (risk of malignancy)
- Failure of medical therapy
Considerations (if for phaeochromocytoma)
- Alpha blockade (doxazosin)
- Beta blockade (atenolol)
Right adrenalectomy
- Supine + GA + Prepare/drape
- Transverse supra-umbilical incision made with upward convexity
- Access adrenal gland
- Mobilise right colic flexure, retract downwards, retract liver upwards
- Incise posterior peritoneum above level of upper pole of right kidney
- Expose IVC, right adrenal gland
- Dissect / remove adrenal gland
- Separate from kidney and perinephric fat / fascia
- Dissect off IVC
- ligate vessels
- Dissect out
- Ensure haemostasis
- Close wound in layers
Post-operative considerations
- 30mg po hydrocortisone/day
- Fludrocortisone 0.1mg/day
